The changing educational culture in medical schools

cul·turenoun \ˈkəl-chər\: the beliefs, customs, arts, etc., of a particular society, group, place, or time

Culture is inevitable; you will find it in any possible group of people. Within the medical profession and medical schools this isn’t any different; you could ask any doctor or medical student about typicalities they find in their working environment, either good or bad. Teachers tend to say that the conditions have improved plenty: they were completely disrespected as students, and worked way too many hours, so that all students around this time should be thanking their lucky stars they started medical school now and not 20 years ago. Unfortunately when we do look at the educational environment of medical schools, more and more examples of bullying in medical schools and unencouraging learning environments show up in the media, an example being the article published in the New York Time on the "Bullying Culture of Medical School" [1]. Or if we look at the extreme working envirnoments when talking to our fellow medical students from some of the countries in mainly the Asia-Pacific region, where working hours for students last sometimes between 120-140 hours, one might not only doubt the impact on medical students, but on patient care and safety as well.

During the AMEE Conference 2014 in Milan the International Federation of Medical Students’ Associations (IFMSA) together with the World Federation for Medical Education (WFME) and the World Medical Association (WMA) organized a symposium on the culture in medical schools that I was honored to moderate. [2]The symposium started off with a talk from Prof. David Gordon, president elect of the WFME. He gave a brief overview of the changes medical school culture has gone through since he was a medical student. He also talked about the faculty’s perspective on the culture of medical schools, and in his opinion: “Med school culture should be one of a community, not ‘us’ and ‘them’. We need to work together and think 50 years into the future, and move away from our culture of short term thinking”. Professor Gordon was asked about how he saw the role of international organizations within changing the culture in medical schools. “We need to make the case for a better culture of social accountability, and be responsive to the needs of society.” Prof. Gordon emphasized the importance of students as prime movers and change makers, and vouched for the importance of joining the discussion with students throughout culture reform.

The doctors’ perspective on culture in medical schools was explained by Dr. Otmar Kloiber, Secretary General of the WMA. He related the subject to ethics: “Ethical behaviour needs to be lived and not demanded”, and called for more emphasis on the importance of doctors as role models in healthcare. He used the example of the ‘Declaration of Geneva’, [3.] adopted by the 2ndGeneral Assembly of the World Medical Association and often referred to as the modern version of the Hippocratic Oath. “Whereas the Declaration of Geneva refers to students giving teachers the respect and gratitude that is their due, the Hippocratic Oath contains an element that sometimes seems to have gone lost. It states the obligation of doctors to be teachers as well”.

Mr. Agostinho Sousa, IFMSA Liaison Officer for Medical Education issues ended the symposium with a closing speech on the students’ perspective on culture in medical schools. What do students need? How can we together create the most stimulating learning environment? The important message he ended with is that people always say that students are the future, the ones that will change everything. But doesn’t it start right now? With the people that are currently in the role of doctors, deans and educators? They are the ones that need to lead the changes that have to be made in the culture in medical schools, and students are more than happy to provide any support they can give.

We do however applaud the increase of medical schools recognizing the existing problems and taking the first steps to publish them, so that we can actually work on improving them. A recent example coming from the UK by Dr. Anja Timm whom I met during the AMSE conference 2014 in Berlin, a survey reporting on undergraduates' exposure to bullying and harassment in their first placement year, [4] where she perhaps very rightfully wrote in the title of the article: "It would not be tolerated in any other profession except medicine". When attending a session last year during the IFMSA August Meeting in Chile facilitated by my collegues from AMSA USA, it came to light that almost none of the medical students present actually had any type of reporting system within their medical schools to address these harassments when faced. But there are also some beautiful examples of action taken within the field of Student Rights and Wellness. At the AMEE Conference 2014 sessions that I attended I came accross a brilliant student led initiative at QUB called "Mind your Mood", which is a university campaign on student welfare services. But the topic of student welfare itself would deserve more pages than would be fit for a single blogpost.

In conclusion, we call for an encouraging learning environment in medical schools, where there is mutual respect between teacher and student. We call for all groups: Medical Schools, Teachers, Medical Students, Society and Doctors to take their active role into ensuring the wellfare of our medical students, as their ability to perform will ultimately influence patient care and patient safety. We encourage medical schools to work with medical students on implementing systems for the reporting of bullying and harassment and the implementations of systems that support student (mental) wellbeing. We as IFMSA commit to doing our part in advocating for Student Rights and Wellness and will continue our efforts within this field. [5].

“Culture is the process by which a person becomes all that they were created capable of being.” – Thomas Carlyle